The State of Hawaii Med-QUEST Division (MQD) provides eligible low-income adults and children access to health and medical coverage through managed care plans. The QUEST program is designed to provide Quality care, Universal access, Efficient utilization, Stabilizing costs, and to Transform the way health care is provided to recipients. MQD Accomplishments 2010-2014

The benefits of QUEST Integration include more health plan choices for aged, blind or disabled individuals, and a greater ability for a beneficiary to remain with the same health plan upon turning 65 or developing a disability. Additionally, eligible beneficiaries will gain expanded access to home and community-based services to prevent decline to institutional level of care. QUEST Integration also reduces administrative burden by creating a single managed care program.

Step 1: Learn About Your Choices

Choosing a health plan is important. You’ll get all your health care services from a single health plan. The health plan can help you find doctors, hospitals, and pharmacies.

When you’re choosing a health plan, it’s a good idea to see if you can:

Keep seeing your current doctors.

Go to the hospital, care facility, or pharmacy you prefer.

Health Care Provider Network

The health plans participating in QUEST Integration are AlohaCare, Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan (Oahu & Maui only), ‘Ohana Health Plan and UnitedHealthcare Community Plan. (See below for contact information). If there’s a specific provider you want to see, visit the QUEST Integration health plans’ websites, or call to ask if the provider is in their network.

If your current provider doesn’t accept QUEST Integration (Medicaid) health insurance, call your health plan to help you find another doctor or provider.

Health Plans

Phone

Website

AlohaCare

1-877-973-0712

alohacare.org

HMSA

1-800-440-0640

hmsa.com

Kaiser Permanente

1-800-651-2237

kpinhawaii.org

‘Ohana Health Plan

1-888-846-4262

ohanahealthplan.com

United Healthcare Community Plan

1-888-980-8728

uhccommunityplan.com

Step 2: Choose a Health Plan

When you become eligible for Medicaid, the Department of Human Services assigns you to a health plan right away. You can stay with the health plan that Med-QUEST assigned to you or you can choose a different health plan.

If you stay with your assigned health plan, you don’t have to do anything.

If you choose a different health plan, you must:

Tell Med-QUEST Enrollment Services Section of your new choice within fifteen days of receiving a choice notice from them.

Your new health plan will start on the first day of the following month. Until then, you’ll stay with the health plan you were assigned.

If you stay with your assigned health plan or choose a different health plan, you can change plans once within 60 days of the day you are enrolled in QUEST Integration. Once the 60-day period ends, you can change your health plan only during open enrollment.

How many health plans can I choose from?

Your five choices for a QUEST Integration health plan are:

Aloha Care

HMSA

Kaiser Permanente (Oahu and Maui only)

‘Ohana Health Plan

United Healthcare Community Plan

Get Started With Your New Plan

After you choose a QUEST Integration health plan, your plan will mail you:

You’ll get a notice in the mail that tells you about the health plan you’re enrolled in. Take the notice with you to your doctor or other service provider to get medical care. Once you get your health plan ID card, you can use your card to get services.

Choosing a primary care provider (PCP)

Your health plan will mail you a welcome packet. Inside the packet you’ll find a form asking you to choose a primary care provider (PCP). Your PCP will see you for regular checkups or when you’re sick. When you need a specialist or other medical services, your PCP will arrange it for you. If you need help finding a PCP or specialist, ask your health plan for help.

If you received services before you got the Med-QUEST enrollment notification, tell your PCP or other service provider. Your health plan may cover some of these services.

You’ll have 15 days to choose your PCP. If you don’t let your health plan know of your choice within that time, they’ll assign you a PCP. You can change your PCP at any time.

Learn About Your QUEST Integration Benefits

Primary & Acute Care Services

Dialysis

Medical transportation services

Durable medical equipment and medical supplies with prosthetics and orthotics

Methadone treatment services, which include the provision of methadone or a suitable alternative (e.g., LAAM)

Psychiatric or psychological evaluation

Long Term Services & Support (LTSS)

Nursing facility

Home- and community-based services including:

Chore

Adult day health

Personal care

Adult day care

Personal emergency response system

Skilled nursing

Residential care like Community Care Foster Family Home or Expanded Adult Residential Care Home

Does QUEST Integration cover medical and bills I already have?

If you utilized medical services occurring a maximum of 10 calendar days before the date we receive your application, those services will be covered if a medical provider provided the medical service. Make sure that you check off the box asking about outstanding medical bills when you submit your application.

After I choose my medical plan, will I have to stay in that plan forever?

No. You may change your medical plan once a year during the “Annual Plan Change Period,” with changes effective January 1. Except during this annual plan change period and some exceptions, you must stay in your medical plan once you have chosen them.

Are you under 21 years of age? Get free physical exams!

The Early Periodic Screening, Diagnostic, and Treatment (EPSDT) program lets children and young adults under 21 get free:

Complete medical and dental exams;

Developmental, autism, and lead screening;

Hearing, vision, and laboratory tests; and

Immunizations and tuberculosis skin tests.

The notice here will provides more information about other covered services that you may take advantage of, including autism services. You’ll also get help setting up appointments and arranging transportation. Call your health plan for more information.

Urgent care centers

If you can’t get an appointment with your PCP, you can go to an urgent care center. Urgent care centers can treat you for an illness or injury that requires immediate care, but isn’t serious enough to visit an emergency room. You don’t need an appointment to be treated at an urgent care center.

After-hours care nurse line

Each health plan has its own after-hours care nurse line, where you can get medical advice and guidance. The lines operate 24 hours a day, seven days a week.

Call your plan’s nurse line if you have questions about a medical condition or you’re not sure if you should visit an emergency room.

All health plans have a member grievance and appeals process to help address any problems. If you’re concerned about your medical care or services, contact your health plan’s customer service department. The phone number is printed on the back of your membership card.

If you can’t work things out with your health plan, you can contact the state-designated QUEST Integration Ombudsman in your county. The ombudsman can help if you have problems with your health plan or don’t agree with the health plan.

Call the Med-QUEST Division Eligibility Offices to report all changes within 10 days of learning of them. If you don’t report changes, it may affect your eligibility for medical assistance. Changes include:

Income

Address

Living arrangement

Marriage or divorce

Pregnancy

Birth

Death

Health insurance coverage

Getting or changing a job

Injuries from accidents

Receipt or sale of any asset

Receipt of a Social Security number

You must also report when you enter a hospital or public institution or move out of the state of Hawaii.

Oahu PHONEFAX

Applications 587-3521 587-3543

Ongoing 587-3540 587-3543

Kapolei Unit 692-7364 692-7379

Hawaii Island

Hilo (East Hawaii) 933-0339 933-0344

Kona (West Hawaii) 327-4970 327-4975

Maui 243-5780 243-5788

Kauai 241-3575 241-3583

Molokai 553-1758 553-3833

Lanai 565-7102 565-6460

After I choose my medical plan, will I have to stay in that plan forever?

No. You may change your medical plan once a year during the “Annual Plan Change Period,” with changes effective January 1. Except during this annual plan change period and some exceptions, you must stay in your medical plan once you have chosen them.

How do I know when to contact the State and when to contact my plan? You should contact the State if:

you have a question about eligibility

you get a job or change jobs

your income, assets or address change

you have a change in your family, such as a birth, a death, a divorce, a marriage or someone moves into or out of your home